A physician who is on trial in a federal courtroom along with two other health care professionals, all accused of conspiring to illegally distribute pain and anxiety medication, testified Tuesday that she had no idea the Little Rock clinic she supervised in 2014 was a "pill mill."
Felicie Wyatt, who now lives in Jackson, Miss., testified that she was working part-time at the Veterans Affairs medical center in Jackson when she saw an ad on a medical website for a supervising physician needed in Little Rock. She said the owner of the clinic, Stanley James, called her shortly after she sent in her resume.
James has pleaded guilty to drug distribution charges in federal court in Texas, where he operated other clinics that prosecutors say were pill mills. John Christopher Ware, an associate of James' who co-owned the Artex clinic on Hermitage Road in Little Rock, which operated for about four months in 2014, is among several people awaiting trial on similar charges in Texas.
Wyatt testified that James told her that he needed a physician to visit the Little Rock clinic about once a week to review charts of patients who were seen by midlevel providers. Physician's assistant Aaron Paul Borengasser and nurse practitioner Kristen Raines, both of whom are on trial alongside Wyatt, worked at Artex, one after the other, under Wyatt as the midlevel providers.
Wyatt, represented by Little Rock attorneys Arkie Byrd and Richard Mays, testified as the defense began presenting evidence after more than a week of testimony by prosecution witnesses. She said she and James agreed that she would be paid $3,000 a week for her services at the clinic, which James told her was to be a "primary care" clinic with a variety of services.
Although she saw no equipment at the clinic, Wyatt said, she didn't think it was odd, because the clinic was just starting up and James assured her that equipment such as X-ray machines and electrocardiogram machines was coming.
Her first day was June 14, 2014, she said. While prosecution witnesses have testified that the clinic parking lot was often full of cars, many owned by people who had driven at least two hours to be seen at the clinic, Wyatt said her impression that first month was that "business was slow."
"I just saw a normally functioning clinic," she testified, adding that she never saw security guards.
Prosecution witnesses have testified that armed guards allowed only three patients to enter at a time and screened them for weapons. They have also said that all patients paid $150 to $200 cash to be seen at the clinic and were encouraged to report a high degree of pain and anxiety. Witnesses have said that whichever health care professional each patient saw was instructed to issue a prescription for a full month's supply of the highest doses available for hydrocodone, a pain medication, and Xanax, an anti-anxiety medication, as well as a third medication such as a muscle relaxer or blood pressure medication.
The prescriptions could only be filled if all three medications were sold at the same time, prosecutors say. They say the combination is known in the illicit prescription drug market as the "holy trinity" of drugs that create a high similar to heroin, though Wyatt testified that she has never heard the term before.
Questioned about whether she thoroughly reviewed Borengasser's and Raines' records, or just accepted money for claiming that she did, to allow the clinic to continue practicing, Wyatt noted that she did voice some concerns about Borengasser. She said she wanted to be sure that he was treating patients individually because of similarities she noticed in the prescriptions he wrote under her authority for many of his patients.
She said she also suggested that he prescribe lower doses initially or use less potent, noncontrolled substances first.
"I know that on July 2, I told the owner that I no longer felt comfortable working with him ... because he wasn't following my instructions on treatment of pain patients," she testified.
Wyatt also said she had no idea that the clinic operated on a cash-only basis, because she remembered filling out paperwork for insurance companies and Medicare.
Assistant U.S. Attorney Anne Gardner questioned Wyatt about a letter she wrote to the state Medical Board in which she said she would be working full-time at Artex, when she was also working full-time in Mississippi.
Wyatt said the letter was written before she got word that her part-time job at the hospital in Mississippi was available as a full-time job.
"The truth is, you collected your paycheck and just let that clinic run however it was run," Gardner said. "Isn't that true?"
"No ma'am," Wyatt replied. "I reviewed those charts and I provided feedback on improvements."
The trial resumes at 9 a.m. today before U.S. District Judge James Moody Jr.
Metro on 08/10/2016